Journal: British Journal of Surgery Author: M.P. Schijven, R.K. Reznick, O.Th.J. ten Cate, T.P. Grantcharov, G. Regehr, L. Satterthwaite, A.S. Thijssen, H.M. MacRae Publication Date: Jan 2010 Volume Number: 97 Issue: 3 Page Numbers: 443-449
Description: Working time directives in health care are a big issue with a potential effect on the quality of clinical training and the competence of doctors and specialists. Specifically in the surgical domain, the attainment of practical and cognitive skills in a limited number of hours per week – 70 to 80 hours per week in North America versus 48 hours in the EU has evoked discussion. Are North-American surgeons more proficient at the end of training than their European colleagues?

This question was addressed in a recent study by researchers from the University of Toronto, Canada and Utrecht University, the Netherlands in a comparative study. A sample of 21 surgeons at the start of their professional career in Canada went through a battery of different tests and was compared with a similar Dutch sample of 21 surgeons taking identical tests. Dutch surgeon-examiners flew to Toronto to participate a multi-station skills test (OSATS), a clinical management test (PAME) and a knowledge test (CIP). Within a few weeks, materials and surgical examiners from the Toronto skillslab and surgery department were shipped to the Netherlands to establish identical conditions to test the Dutch sample.

In the British Journal of Surgery, it was shown that the Canadian surgeons did not significantly differ in technical skills and knowledge, but outperformed the Dutch in clinical management. An interesting finding was that Canadian examiners tended to favor Canadian candidates and Dutch examiners Dutch candidates – which may say something about cultural differences.



This is the first rigorous transatlantic comparative study that addresses the issue of working time restrictions.

SUBMITTED BY: Olle ten Cate
Support links: Transatlantic comparison of the competence of surgeons at the start of their professional career